IntroductionRenal cell carcinoma (RCC) represents approximately 2% of all tumors, and about 30% of patients are affected by metastatic lesions at diagnosis (1,2). About 20% to 40% of patients develops a metastatic disease after nephrectomy (3) and lung is one of the sites most frequently affected by RCC metastases (second after liver) (4). Patients that receive no treatment for metastatic RCC (mRCC) have a 0-18% 5-year survival (5). Nonsurgical therapy for mRCC has limited efficacy, with a median overall survival (OS) reported between 26.4 and 32.0 months (6,7) for mRCC patients receiving several agents targeting angiogenesis or the mTOR pathway, in addition to traditional chemotherapeutic regimens and immunotherapy (8). On the contrary, the 5-year survival rates data published in literature after pulmonary surgery for metastasectomy from 36-54% (9,10), emphasizing the role of surgery as the Background: The lung is one of the sites most frequently affected by metastatic renal cell carcinoma
Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.
Pulmonary lobectomy has been considered as the standard surgical procedure for lung cancer, since the prospective randomized controlled study published by the U.S. Lung Cancer Study Group in 1995 (1) showed a lower local recurrence rate and a better long-term survival rate when performing lobectomies compared to sublobectomies.Nevertheless, technical advances in non small cell lung cancer (NSCLC) early diagnosis and in thoracic surgery techniques have changed the treatment approach to early stage NSCLC (2,3). The extensive application of highresolution computed tomography (HRCT) in NSCLC screening programmes for high-risk former smokers has increased the detection of an even greater number of tiny NSCLC (<2 cm) and pure ground-glass opacity (GGO) lesions (4). This phenomenon has led to a modification of the 8th Edition of TNM classification of lung cancer (5), introducing tumors of ≤1 cm that are classified into a new T1a group, and had also led to the inclusion of the presence of GGO lesions as a radiological classification criterium suggestive of minimally invasive or noninvasive NSCLC (6).This scenario has renewed surgeons' interest in sublobar resections, not only for high-risk but also for fitting patients with early stage I NSCLC.Simultaneously, anatomical segmentectomies (introduced as a surgical approach to benign lesions in 1939) has reemerged as a treatment option for such less-invasive NSCLC.Compared with wedge resections, typical segmentectomies can ensure an adequate distance of the lesion from the margins, thereby reducing tumor recurrence and improving long-term survival (7) resulting in the most tailored surgical approach in the landscape of personalized medicine.
Background: Multiportal thoracoscopic approach is already a well standardized procedure for minimally invasive esophagectomy (MIE); conversely very few reports have been published about uniportal videoassisted thoracic surgery (VATS) technique till now. We present our preliminary experience with uniportal VATS esophagectomy, evaluating short-term outcomes as perioperative mortality, complications, oncological radicality, postoperative pain and cosmetic results. Methods: From December 2016 to November 2017, the prospectively collected clinical data of 12 patients, who underwent uniportal VATS esophagectomy and reconstruction with a stomach conduit, according to McKeown technique, were reviewed and outcomes evaluated. Results: The mean age of population was 60.67±8.61 years. Ten (83.3%) patients were males. The main histological type was a squamous cell carcinoma in six patients (50%). No patient had a local recurrence. After 4.33±3.31 months 10 patients (83.3%) were alive with no evidence of disease; 2 (16.7%) patients died of other causes. Two (16.7%) patients developed an anastomotic leak (treated conservatively) and one (8.3%) patient a chylothorax (which required a surgical treatment). The mean operative time of uniportal VATS esophagectomy was 104.67±20.66 min. Mean number of thoracic nodes removed was 10.44±3.94. Postoperative hospitalization was 15.73±14.29 days (median of 9 days). The mean level of pain was 1.92±0.90 in first postoperative day with a duration of 2.25±1.54 days. Cosmetic result was 2.42±0.79 on a 3-point scale. Conclusions: Uniportal VATS esophagectomy seems to be a safe, feasible and effective alternative to multiportal VATS in terms of operative time, postoperative mortality, hospital stay and oncological outcomes. Less postoperative pain and better cosmetic results seem to be some advantages in favor of Uniportal VATS, however further studies with longer follow-up are claimed.
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